Treatment of tibiofibular syndesmotic ankle injury remains controversial in regard to the best method, although surgeons agree that the goal of treatment is reduction and operative stabilization. Ideally, the implant should stabilize the syndesmosis and allow physiologic micromotion and early mobilization, and conventional screws are limited in this regard. We reviewed use of the Ankle TightRope^® fixation device for repair of syndesmotic injuries. From April to September 2006, 16 patients with evidence of syndesmotic injury were treated by means of ankle fracture open reduction with internal fixation, combined with use of the Ankle TightRope^® device for repair of the syndesmosis. The mean age of the 16 patients was 36.6 ± 16.71 (range 15 to 69) years;​ they were followed up for at least 2 years. Mean follow-up duration was 26 ± 3.94 (range 24 to 38) months. The mean American Orthopaedic Foot and Ankle Society score at 2-year follow-up was 86.88 ± 11.49 (range 48 to 100). The mean time to full weight bearing was 4.5 ± 0.87 weeks. Two (12.5%) patients had postoperative superficial wound infections, each of which was treated with oral antibiotics. One (6.25%) patient had the TightRope^® removed because of irritation from the knot. There was no failure of syndesmotic fixation, despite early weight bearing in the postoperative phase. The results of this case series indicate that tibiofibular syndesmosis repair with the Ankle TightRope^® yields satisfactory results.